Tuesday, September 13, 2011

The Morning Drill: September 13, 2011

If dog is man's best friend, it's especially true when he's in a dentist chair. For many patients who see Lori Doran-Garcia, DDS, a general practitioner in Palo Alto, CA, the first thing they want before treatment starts is to have her pet pug, Buster, nestled in their laps.

"He really is what got me in here; the minute I heard about Buster, I came," said patient Patricia Urbano as she stroked the portly canine snoozing in her lap. "I have really bad anxiety and didn't go to the dentist for a couple of years because I had a bad experience. He really calms me -- the love and the warmth in my lap."

Dr. Doran-Garcia began bringing Buster to her Palo Alto office four years ago to crate train him. "But all my patients kept asking to hold him as a puppy," she recalled. "It was totally serendipitous."

Buster was soon a hit with patients, and he learned to become perfectly still. In fact, the 25-pound canine seems to see comforting patients as his duty.

Adults as well as kids ask for him, Dr. Doran-Garcia noted, and many that used to need nitrous oxide to calm them now request Buster instead.

"Drilling doesn't bother him," Dr. Doran-Garcia said. In fact, he often snores because the sound puts him to sleep.

It's long been known that obesity increases diabetes risk, but a new study finds that the amount of excess weight someone carries -- and how long it's carried -- can make that risk even higher.

That's especially worrisome given the growing number of obese children and teens who will spend more years of their lives obese than prior generations, researchers from the University of Michigan Health System warn in a university news release.

"Our study finds that the relationship between weight and type 2 diabetes is similar to the relationship between smoking and the risk of lung cancer," said the study's lead author Dr. Joyce Lee, a pediatric endocrinologist at the University of Michigan C.S. Mott Children's Hospital. "The amount of excess weight that you carry, and the number of years for which you carry it, dramatically increase your risk of diabetes."

This has the potential to continue to push up rates of diabetes in the United States, Lee added.

"We know that, due to the childhood obesity epidemic, younger generations of Americans are becoming heavier much earlier in life, and are carrying the extra weight for longer periods over their lifetimes," said Lee. "When you add the findings from this study, rates of diabetes in the United States may rise even higher than previously predicted."

Researchers examined information on roughly 8,000 teens and young adults and calculated how far above a certain body mass index (or BMI, a calculation based on weight and height) they were and for how long. The study found those with a BMI of 25 or higher (overweight) or 35 and higher (30 and up is obese) for a greater length of time had a higher risk of diabetes.

For example, individuals with a body mass index of 35 for 10 years were considered to have the equivalent of 100 years of excess BMI -- a considerable cumulative "dose" of excess weight.What's more, black and Hispanic participants had a higher risk for diabetes than whites with the same amount of excess weight over time, the researchers noted. Among those with a BMI of 35 or more, Hispanics were twice as likely to develop diabetes than whites. Blacks in this group also had a 1.5 times greater risk of developing diabetes than whites.

Despite a mandatory vaccination law that followed a pertussis outbreak last year, some California students are returning to class this fall without their TDAP booster shots.

The immunization law, passed last September, required that junior high and high school students show proof of a TDAP booster, the vaccination that prevents pertussis, also known as whooping cough, by the first day of school. Another bill passed this summer gave students an additional 30 days to get vaccinated.

Why the delay?

California Immunization Coalition director Catherine Flores Martin said that as of May, CIC had heard from about 20 percent of the state’s schools that their students would likely miss the immunization deadline.

This is the first time that the state has had to get a population of this magnitude in compliance with a new law, said Linda Davis-Alldritt, California Department of Education School Nurse Consultant. The whooping cough vaccine is the first immunization law that affected high school students, she said.

“Word has gotten out, but mobilizing the state as a whole is like moving a battleship. It takes a lot of effort to move such a big object in one direction,” Davis-Alldritt said.

The Santa Ana school district is at about 80 percent, said Angela Burrell, spokeswoman for the Santa Ana Unified School District. The district expects they will get the last fifth of its student population vaccinated within the new 30-day extension, given the resources available at nearby pharmacies and the county.

As far as how other school districts are faring, Davis-Alldritt says that there was no provision in the original law that authorized the CDE to collect information about specific schools and districts.

Getting exercise, achieving a healthy weight, avoiding smoking — those steps are a standard prescription for people who want to lower their risk of cardiovascular disease.

But according to a new review of previously published studies, they’re also a good way to improve erectile dysfunction. According to their review, those lifestyle interventions (on their own and combined with statin drugs) were associated with a statistically significant improvement in sexual function, write the authors of the new analysis, published online in the Archives of Internal Medicine.

“If you help the blood flow in one area, you can help it in another,” Stephen Kopecky, an author of the study and a preventive cardiologist at the Mayo Clinic.

Kopecky tells the Health Blog that not all men who experience erectile dysfunction have coronary artery disease — a narrowing of the blood vessels leading to the heart. But ED is a risk factor for CAD, and tends to show up three to five years ahead of heart problems.

That can make it an important warning sign, particularly for younger men. A 60-year-old man with ED has only a slightly higher chance of having cardiovascular disease, he says. But a 40-year-old man with ED is 50 times more likely to have CAD than a contemporary without ED, he says.

Kopecky says ED is also a unique warning sign in another way. It’s no secret that men tend to be reluctant to go to the doctor or to disclose symptoms of potentially dangerous conditions. But while men may not tell their spouses or partners about chest pain that hits while going up the stairs, ED is different. “You can’t hide from it,” he says.